Population health, public health – what’s in a name

Joint blog by me and @andy54321

Everyone is talking “population health” these days. 

 

It’s great that the world is moving to think of populations not just individuals within a population. 

 

In the 00s when “health improvement” was in vogue, many couldn’t see the distinction between that term and “health promotion”. So “population health” could be seen as a phrase, so is “public health”, so is “population medicine”, history shows these being bandied around until one national body or another  makes a call. 

 

The inimitable Dave Buck recently asked one of us to distinguish. He suggested to us a two min view

Is the term, however, simply emperors new clothes for public health (in drag), is there a distinction between the terms. His two minute answer is here

We don’t profess to know the answer, there might not be an answer, we suggest a few reflections. 

 

 

 

Definitions 

Here’s the wikipaedia definition of population health……….’defined as”the health outcomes of a group of individuals, including the distribution of such outcomes within the group”. It is an approach to health that aims to improve the health of an entire human population.’

 

And for public health……..’the science and art of preventing disease, prolonging life and promoting human health through organized efforts and informed choices of society, organizations, public and private, communities and individuals. It is concerned with threats to health based on population health analysis’. There’s umpteen curriculum statements, training programmes and the like.

 

Similarities?

In our original off the cuff view, in a world of overlapping circles in a Venn diagram, there isn’t much overlap here. We just cant see much of a distinction between the two terms 

It’s worth saying this was from our perspective as trained and experienced public health specialists. This gives us a certain lens and the biases that go with it. Others, with different experience and training may see it differently.

Both are about “health” – which obviously isn’t just “health services”, but something broader.

Both are broadly about populations and the individuals within it.

Broadly starting point is population rather than individual.

This should affect the strategy and the mission, often we talk populations but act in an individual focused way. Tricky.

Both are inherently about allocative value – getting better outcomes out of the £ put in… but almost universally is “going upstream sort of stuff”.

Both have many domains and lenses – from intelligence, data and evidence, social / political / environmental sort of things, treatment care and support sort of things etc

If anything population health often seems to be the term increasingly preferred by clinicians and health care management types as they can distinguish this from rats and drains and “town hall public health”. 

 

 …..”there is also resistance on the part of clinicians to the brand of public health, which they still see as being associated with a 19th century agenda; the term ‘drains’ is still used by some clinical colleagues”. Gray and Ricardi 

 

In this vein. there was a move to a term of population MEDICINE a few years ago. Obviously there the locus there mnay be on health care delivery (rather than health per se?). It’s worth noting the Faculty of Public Health dropped the M word years ago and is still standing. 

 

Perhaps what population health is NOT

Furthermore, we often spot that population health is shorthand for analytics, actuarial level population segmentation and (maybe worse) the notion that high tec gizmos and gadgets will be the saviour of our problems.

We don’t agree. Population health is not (only at least) gizmos and actuarial analysis, its determinants / real pop needs / doing right things with right set of services and interventions. Actuarial type analysis, segmentation and sophisticated population level risk management is a part of that, but part of a larger whole.

An over focus on actuarial and analytics also overtly draws minds eye to the top of triangle, the most poorly, the most visible, tangible, kickable, identifiable……and notion that “we can do something here”….(Which is NOT borne out by evidence). IF we always always start here, we will never get beyond the “high risk”, the frequent flyers etc, garunteed.

This will inadvertently lead to under focus in human and system aspects, basics of population approach.

And gizmos…….Gizmos may be a part of that if someone can demonstrate they make a difference on a population scale (hint we’re talking population health thus population outcomes matter) and are worth it (cost effective) and affordable.
 

The distinction.

If there IS a distinction in the terms, is that borne of your worldview and starting point. 

 

If we have to separate them them  it may be helpful to think firstly re what is the vision? Is the vision the same? If so, then choosing a badge is less important. 

 

Secondly, it may be helpful to consider what is the approach/methodology? Now it gets interesting, there might be a case for delineating the “soft” and “hard” – the “heads up” vs. the “heads down”, the “engagement and strategic influencing” vs. “systematic methodology”, the geek vs. the leader. All are needed.

 

Are the competencies required to execute ‘population health’ and ‘public health’ are probably the same. And the curriculum to train folk – probably pretty similar. All clinicians can benefit from an understanding of the nature and extent of variation in equity of access and equality of outcome on their patch. The lessons of Geoffrey Rose are important, enduring, often forgotten and ignored at our peril. Martin Roland repeats these from time to time! You have been warned.

 

Inseparable?

So, having thought about it, we can’t really separate them.

 

There’s a need to be clear about whether we are discussing one and the same thing, or whether there truly are a number of evolving strands of classical Public Health which need to be defined further

 

Yes of course there is an element of semantics (well, lexical semantics – the analysis of word meanings and relations between them) but we’re all savvy enough to know what we’re talking about here so we can move on. 

 

But basically our Venn diagram is a rectangular box with ONE circle in it an few overlaps…..

Should there be? We don’t know 

 

 

References 

 Geoffrey Rose’s 1985 paper Sick Individuals and Sick Populations in the International Journal of Epidemiology: http://ije.oxfordjournals.org/content/14/1/32.full.pdf+html

 

Roland. Reducing emergency admissions: are we on the right track https://www.ncbi.nlm.nih.gov/pubmed/22990102 
From public health to population medicine: the contribution of public health to health care services. Muir Gray, Walter Ricciardi . doi:10.1093/eurpub/ckq091 

 

Designing healthcare for a different future. Muir Gray. Journal of the Royal Society of Medicine; 2016, Vol. 109(12) 453–458. DOI: 10.1177/0141076816679781

 

https://en.m.wikipedia.org/wiki/Population_health

https://en.m.wikipedia.org/wiki/Public_health

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4 Comments

  1. Interesting article on what might be seen as a pedantic topic… I often avoid the term ‘public health’ in public (writing, speaking).I think it’s poorly understood & confused with public health care – maybe especially in the states and in discussions of privatisation. So it that context, brief mention of public health may be interpreted as a left wing agenda?

    I was interested in David Buck’s comments that public have an understanding of population health, but not of public health. As you say, I think this term developed from population medicine, and has connotations of precision medicine, risk stratification, maybe big data or open data.

    I often use the term community health to try to describe analysis or action at the community level, which would not be relevant at the individual level. Also my interests are around shaping according to context & community (or targetting) rather than population-wide. It’s a bit like the difference between sociology & psychology- they have overlaps & can be complementary, but also distinct answers & perspectives (& territory wars!)

    Next up… a discussion of similarities between health & safety & environmental health, and their defenses against agenda of cutting red tape…??

    Like

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